Rima Himelstein, M.D.

Adolescent Medicine Specialist at Crozer-Keystone Health System

There’s good news and bad news about teens and smoking. First, the good news: Fewer teens are smoking cigarettes, according to the Center for Disease Control and Prevention’s National Youth Tobacco Survey (NYTS). The survey includes more than 24,000 students in grades 6-12 from all 50 states and the District of Columbia. In 2012, 14 percent of high school students said they smoked cigarettes in the prior year, which is down from 16 percent in 2011 and down from 28 percent in 2000.

Now the bad news:More teens are using e-cigarettes. According to the NYTS survey, the percentage of middle and high school students who had ever used an e-cigarette doubled from 3.3 percent in 2011 to 6.8 percent in 2012 — estimated to be about 1.78 million teenagers. About 1 in 100 middle school students had used e-cigarettes in the month before the survey, and even more high school students had used them in the month before — almost 3 in 100.

What are e-cigarettes? They’re electronic cigarettes, battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol. Depending on the brand, e-cigarette cartridges typically contain nicotine, a component to produce the vapor (usually propylene glycol or glycerol), and flavorings (such as tobacco, fruit, mint, or chocolate).

How do they work? When the user takes a “puff” from an e-cigarette, a wire inside the device heats a liquid containing nicotine, turning it into a vapor — which looks like smoke. The user inhales the vapor. Depending on the brand, each cartridge is designed to produce about 250-400 puffs, about the same number of puffs from one to two packs of tobacco cigarettes, according to a recent issue of The Medical Letter.

Do they make the grade in helping people quit? Although e-cigarettes have been promoted to help people quit smoking, there is no scientific evidence for this claim, according to the World Health Organization (WHO). For example, a recent study reported in the medical journal, Lancet, compared three groups of smokers who used either a nicotine e-cigarette, a nicotine skin patch, or a placebo (“fake”) e-cigarette to help them quit smoking. At six months, there was no statistically significant difference between the three groups in the percentage of patients who quit.

Some people think that they’re safer than regular cigarettes. Based on results from the NYTS survey, an estimated 160,000 students are probably thinking just that. This is the estimate of teens who have used an e-cigarette but never a conventional cigarette. “This is a serious concern because the overall impact of e-cigarette use on public health remains uncertain,” the CDC report says. In an analysis of two different brands of e-cigarettes, the FDA found a number of contaminants, including cancer-causing chemicals. Sound familiar?

Why aren’t people aware that e-cigarettes contain cancer-causing chemicals? Because e-cigarettes are not regulated by the FDA — so they do not have to “follow the same rules” as other nicotine products. This means that the amount of nicotine and other harmful ingredients in each cartridge is not always the same. The American Academy of Pediatrics, among others, is concerned that nicotine could hurt the adolescent’s developing brain and lead to nicotine dependency, including traditional cigarettes.

Easy access to e-cigarettes. More than half of states allow children of any age to buy e-cigarettes. They’re also easy to get online and at mall booths. Some states, including Pennsylvania, prohibit sales to minors.

The AAP, CDC and other agencies are worried about e-cigarettes. Using e-cigarettes can kill: most cartridges have 20 milligrams of nicotine and can lead to nicotine addiction. What’s more, a dose of as little as 10 milligrams of nicotine can be fatal for a child.

What we have here is a rising epidemic. We all need to be worried. It’s time to talk to our children.